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My fiancé
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My fiancé

My fiancé has been having chest pain every month for the last year, it has been sometimes more than once a month. He is a 24 year old male nonsmoker, nondiabetic with left sided pain along his midclavicular line around the 4 through 6 intercostal spaces/ ribs. He has been to the ER twice in the last year, but the ambulance has been called more times than that. The EKGs and blood work have come back normal apart from a high ATL level of 58U/L. His BP the other day (11.29.12) was 104 over 84. Pulse Ox on room air was 98%.
In September when he had his stress test, which also came back normal, his BP was 117 over 77. He is 5'11" at about 220-225 pounds. Pulse Oximetry was 98% on room air. His BP did rise to 154 over 70 during the stress test, but he has no discomfort during the test. His primary care doctor was trying to let it go on to just GERD, but he has no heartburn or trouble eating. The pain is not localized in the sternum or esophagus.
During the "attacks" he has had heart palpitations, a burning/tearing/ pressure on his chest. He gets Dyspnea and sweats excessively. When he breaths during the attack, it hurts more. He said when he has his last attack which was 11.24.12, it was the worst pain yet. It felt like someone was reaching inside and pulling his heart and muscles out. It was an excruciating pain that made him collapse at work.  He has little to no stress and relieves it well. The attacks are not around when he is stressed or anxious.

Family History: No known heart diseases in his family. Only Heart Attack was his Grandfather. His mother has since passed from post op medication reactions after BKA. Father is in good help. His twin brother had a club foot and has been on pain management ever since, but no other complications.

Any ideas on what might be wrong with my Fiancé?

Any ideas will be greatly appreciated.

Rachel
Avatar_dr_f_tn
Hello and hope you are doing well.

If a cardiac cause for the pain has been ruled out, the pain can also be due to orthopedic related causes like cervical rib, cervical spondylosis or disc prolapse. Sometimes it can be costo-chondritis, inflammation of the sterna rib junction. Sometimes the pleura, the lining of the chest cavity and lungs can get inflamed causing pain with coughing. A simple x-ray will help and an orthopaedician can guide you.

Hope this helped and do keep us posted.
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